Systemic Inflammatory Response Syndrome (SIRS) and MODS

Question 1

overwhelming inflammatory response in the absence
of infection causing relative hypovolemia and
decreased tissue perfusion

Answer 1

SYSTEMIC INFLAMMATORY RESPONSE
SYNDROME

Question 2

There is local cytokine production with the
goal of inciting an inflammatory response thereby
promoting wound repair and recruitment of the
reticular endothelial system

Answer 2

PATHOPHYSIOLOGY (SIRS)
3 Stage Process by Dr. RC Bone
1. Stage I:

Question 3

Small quantities of local cytokines are
released into circulation to improve the local
response. This leads to growth factor stimulation and
the recruitment of macrophages and platelets.

Answer 3

PATHOPHYSIOLOGY (SIRS)
3 Stage Process by Dr. RC Bone
Stage II:

Question 4

PATHOPHYSIOLOGY (SIRS)
3 Stage Process by Dr. RC Bone
Stage III

Answer 4

If homeostasis is not restored, a significant
systemic reaction occurs. The cytokine release leads
to destruction rather than protection.

Question 5

FOUR SIRS CRITERIA

Answer 5

Tachycardia
Tachypnea
Hypothermia
Leukocytosis

Question 6

a bedside prompt that
may identify patients with suspected infection who are
at greater risk for a poor outcome outside the
intensive care unit (ICU).

Answer 6

Q SOFA

Question 7

Leukocytosis, leukopenia, or bandemia - white
blood cells number

Answer 7

> 1,200/mm3, <4,000/mm3 or bandemia
≥10%

Question 8

3 component assessment system with: Q SOFA

Answer 8

1. Systolic blood pressure ≤100 mmHg
2. Highest respiratory rate ≥22 breaths per min
3. Lowest Glasgow coma score <15

Question 9

1. Systolic blood pressure ≤100 mmHg
2. Highest respiratory rate ≥22 breaths per min
3. Lowest Glasgow coma score <15

Answer 9

Sepsis

Question 10

s an illness severity score commonly used
in critical care medicine to predict mortality
upon admission to an intensive care unit.

Answer 10

Acute Physiology and Chronic Health Evaluation
(APACHE) score

Question 11

scoring system was released
in 1985 and included a reduction in the
number of variables to 12.

Answer 11

The APACHE II

Question 12

is well
validated and updated regularly, but its use is
limited by the fact that clinicians must pay to
know and use its equation for calculating
death probability

Answer 12

The Acute Physiology and Chronic Health
Evaluation (APACHE) score version II and III
➢ APACHE III

Question 13

is a mortality
prediction score that is based on the degree
of dysfunction of 6 organ systems.

Answer 13

Sequential Organ Failure Assessment (SOFA)
➢ The Sequential Organ Failure
Assessment (SOFA)

Question 14

assesses six systems in terms of
the extent of dysfunction on the first day of
an intensive care unit (ICU) stay.

Answer 14

The logistic organ dysfunction system
(LODS)

Question 15

6 Systems : Logistic Organ Dysfunction (LOD) Score

Answer 15

Neurologic, Cardiovascular,
Renal, Pulmonary, Hematologic, and Hepatic
systems

Question 16

is altered organ function in an acutely ill patient that
requires medical intervention to support continued
organ function.

Answer 16

MULTI ORGAN DYSFUNCTION SYNDROME (MODS)

Question 17

which occurs most often when the initiating
event is a pulmonary one such as lung injury,
the patient experiences respiratory
compromise that necessitates intubation.
This usually occurs within 72 hours of the
initiating event

Answer 17

Primary MODS

Question 18

Primary MODS
ASSESSMENT FINDINGS

Answer 18

Fever, usually greater than 101° F (38.3° C) (early
indicator)
● Tachycardia
● Narrowed pulse pressure
● Tachypnea

Question 19

It occurs most often in the patient with septic
shock and progressively unfolds over about
1 month.
➢ The patient also experiences respiratory
failure and requires intubation.

Answer 19

SECONDARY MODS

Question 20

SECONDARY MODS
MEDICAL MANAGEMENT

Answer 20

Early detection and documentation of initial signs of
infection are essential in managing elderly patients
with MODS

Question 21

ASSESSMENT
EARLY MODS

Answer 21

Vasodilation and decreased PVR with normal BP
● CO increases to maintain BP
● Hypovolemia due to capillary permeability & interstitial
fluid loss
● Skin: warm, pink & dry

Question 22

ASSESSMENT
LATE MODS

Answer 22

Hypotension
● Weak thready pulse
● ECG: ST & T waves changes (myocardial perfusion)
● Skin: cold, moist, pale, mottling cyanosis

Question 23

PLANNING AND IMPLEMENTATION
❑ Drug therapy MODS

Answer 23

Antibiotics: broad-spectrum until specific organism
identified
● Antacids, histamine antagonists, sucralfate
● Analgesic / anti-anxiety agents